Abstract: FR-PO1029

Recipient Age Is Significantly Associated with Immunological and Infective Complications Post Kidney Transplantation

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Hung, Rachel, Royal Free Hospital, London, London, United Kingdom
  • Basu, Sumoyee, Royal Free Hospital, London, United Kingdom
  • Goldet, Gabrielle, None, Boston, Massachusetts, United States
  • Fernando, Raymond, University College London, London, United Kingdom
  • De Serres, Sacha A., University Health Center (CHU) of Quebec, Laval University, Quebec, Quebec, Canada
  • Bass, Paul, Royal Free Hospital, London, United Kingdom
  • Harber, Mark, UCL centre for Nephrology, London, United Kingdom
  • Salama, Alan D., University College London, London, United Kingdom
  • Magee, Ciara N., None, Boston, Massachusetts, United States
Background

In recent years, there has been a marked increase in the number of older patients (> 65) undergoing kidney transplantation. While there is increasing evidence that the ageing immune system is characterised by immunosenescence, many centres do not have age-specific protocols for immunosuppression. In this study, we sought to examine the effect of recipient age on the development of complications of over- and under-immunosuppression post-transplantation.

Methods

We investigated the outcomes of 90 patients aged > 65 who underwent kidney transplantation in our centre between April 2009-March 2016, 42 of whom were aged >70; these patients were compared to 57 controls aged 18 – 64, who were matched for number of HLA mismatches. Recorded variables included % cRF pre-transplant, rejection, development of de novo donor-specific anti-HLA antibodies (DSA) and development of CMV viraemia post-transplantation.

Results

Interestingly, there were significant differences in the mean %cRF pre-transplant across the groups:18-34, 17.75%; 35-49, 29.65%; 50-64, 36.29%; 65-69, 17.1%; and >70, 8.4%; p=0.008. The rate of rejection was markedly increased in the control group compared to those aged > 65 years (19.3% vs. 11.1%), although this did not reach statistical significance. Conversely, rates of CMV viraemia were significantly elevated in recipients >65 when compared to recipients <65 (75.6% vs 50.9%, p=0.03). Rates of de novo Class I DSA were also significantly higher in the younger age groups (18.8%, 0% & 23.8% in patients aged 18-34, 35-49 & 50-64, compared to 4.2% & 7.1% in recipients aged 65-69 & >70, respectively; p=0.025), while the development of de novo Class II DSA followed a similar trend (6.3%, 20% & 14.3% in patients aged 18-34, 35-49 & 50-64, versus 2.1% & 4.8% in recipients aged 65-69 & >70, respectively; p=0.077).

Conclusion

These data indicate that older recipient age is associated with reduced rates of rejection and de novo DSA but significantly increased infectious complications post-transplantation. Given the significant morbidity consequent to over-immunosuppression, consideration should be given to the development of age-specific protocols for immunosuppression.